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Cost Effectiveness of Interventions for Lateral Epicondylitis

Results from a Randomised Controlled Trial in Primary Care

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Abstract

Objective: Lateral epicondylitis is a common complaint, with an annual incidence between 1% and 3% in the general population. The Dutch College of General Practitioners in The Netherlands has issued guidelines that recommend a wait-and-see policy. However, these guidelines are not evidence based.

Design and setting: This paper presents the results of an economic evaluation in conjunction with a randomised controlled trial to evaluate the effects of three interventions in primary care for patients with lateral epicondylitis.

Patients and interventions: Patients with pain at the lateral side of the elbow were randomised to one of three interventions: a wait-and-see policy, corticosteroid injections or physiotherapy.

Main outcome measures and results: Clinical outcomes included general improvement, pain during the day, elbow disability and QOL. The economic evaluation was conducted from a societal perspective. Direct and indirect costs (in 1999 values) were measured by means of cost diaries over a period of 12 months. Differences in mean costs between groups were evaluated by applying non-parametric bootstrap techniques. The mean total costs per patient for corticosteroid injections were €430, compared with €631 for the wait-and-see policy and €921 for physiotherapy. After 12 months, the success rate in the physiotherapy group (91%) was significantly higher than in the injection group (69%), but only slightly higher than in the wait-and-see group (83%). The differences in costs and effects showed no dominance for any of the three groups. The incremental costutility ratios were (approximately): €7000 per utility gain for the wait-and-see policy versus corticosteroid injections; €12 000 per utility gain for physiotherapy versus corticosteroid injections, and €34 500 for physiotherapy versus the waitand- see policy.

Conclusions: The results of this economic evaluation provided no reason to update or amend the Dutch guidelines for GPs, which recommend a wait-and-see policy for patients with lateral epicondylitis.

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Acknowledgements

The work was funded by the Health Insurance Council Fund for Investigative Medicine and the Netherlands Organisation for Scientific Research. The authors have no conflicts of interest directly relevant to the content of this study.

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Authors and Affiliations

  1. Institute for Research in Extramural Medicine, VU University Medical Center, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands

    Ingeborg B. C. Korthals-de Bos, Nynke Smidt, Maurits W. van Tulder, Daniëlle A. W. M. van der Windt & Lex M. Bouter

  2. Department of Clinical Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands

    Maurits W. van Tulder & Herman J. Adèr

  3. Institute for Medical Technology Assessment, Erasmus University, Rotterdam, The Netherlands

    Maureen P. M. H. Rutten-van Mölken

  4. Department of General Practice, VU University Medical Center, Amsterdam, The Netherlands

    Daniëlle A. W. M. van der Windt

  5. Department of General Practice, Division of Public Health Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands

    Willem J. J. Assendelft

Authors
  1. Ingeborg B. C. Korthals-de Bos

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  2. Nynke Smidt

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  3. Maurits W. van Tulder

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  4. Maureen P. M. H. Rutten-van Mölken

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  5. Herman J. Adèr

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  6. Daniëlle A. W. M. van der Windt

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  7. Willem J. J. Assendelft

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  8. Lex M. Bouter

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Corresponding author

Correspondence toIngeborg B. C. Korthals-de Bos.

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